Treatment of hypertension to prevent impotence

Last week we started to discuss the principles of hypertension treatment. We discussed general principles. This week, I will look at the treatment of pressure, as it applies to men specifically. The general principles are the same for women and men but there are some peculiarities as it applies to men, especially the younger men who are sexually active or are desirous of resuming sexual activity.{{more}} Men would prefer to stop the medication rather than stop sexual activity! So, it is imperative that we use medication with little or no sexual side effects.

These are the principles; these are based on over 20 years of treating hypertension and over 15 of these treating mainly men.

First, start with basic and general principles; these include weight loss, exercise, salt reduction, stress reduction, diet change to effect weight loss and lowering of cholesterol. If men just diagnosed with hypertension should take the above measures to heart and practise them, most mild hypertensives will not need to take medications and those who are already taking one tablet to control their pressures may be able to stop it. In addition, those taking two or more medications will be able to reduce the number of tablets taken. The above measures can be used to treat high cholesterol, diabetes and impotence itself. In other words, there is something to be said about good diet, adequate exercise, weight loss and stress reduction in the treatment of diabetes, hypertension, high cholesterol and impotence. The good news is: it works; the bad news is very few men actually try it consistently. It is only when their lives have been threatened by something like a heart attack or stroke that men then take the whole exercise, weight loss, salt reduction and stress reduction seriously. Then, it may prolong or save life, but not erections, because by the time a stroke or heart attack occurs, impotence has already set in.

Second, I kill two birds with one stone. In other words, instead of using two tablets to treat two different conditions, I use one tablet to treat both e.g. treat prostate and hypertension problems, high cholesterol and hypertension and diabetes and high cholesterol. When it comes to hypertension alone, I combine two tablets into one e.g. atenolol and a diuretic or lisinopril and a diuretic, atenolol and nifedipine or two different classes of diuretics. Sometimes, I use the maximum dose of one tablet before adding another, because younger men prefer to take one tablet rather than 2 or 3. Bigger doses mean a higher risk of side effects, but this has to be balanced against a reduced compliance from taking 2 tablets. Some men do not mind taking two tablets, but the younger men do, so I prefer to either give them the full dose of one and if they have side effects to reduce the dose in order to improve their compliance. Better to have a young patient with a reasonably well-controlled blood pressure taking one tablet than one with an uncontrolled blood pressure who promised to take his two tablets and did not.

Finally, I give a tablet that does not affect the erections. This is especially true for young men who have hypertension. I have seen young men with very high blood pressure who stopped taking their medication because, according to them, “it cut the nature, doc”. There are pressure tablets which are known to cause impotence. Bezide is the worst culprit, but there are others, including atenolol, amlodipine. The ACEIs and ARBs generally do not. Doctors will recognize these medications. The ACE inhibitors are cheap, but tend to cause cough in black people. The ARBs are newer and more powerful, with fewer side effects, but they are more expensive. Next week, we start on prostate issues.

For comments or question contact:
Dr Rohan Deshong
Tel: (784) 456-2785
email: deshong@vincysurf.com